Provider Demographics
NPI:1053320135
Name:DELAGE, MIGUEL A (DPM)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:DELAGE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8900 CORAL WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2075
Mailing Address - Country:US
Mailing Address - Phone:305-693-5817
Mailing Address - Fax:305-223-1005
Practice Address - Street 1:8900 CORAL WAY STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2075
Practice Address - Country:US
Practice Address - Phone:305-693-5817
Practice Address - Fax:305-223-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1494213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041224400Medicaid
FL87796Medicare ID - Type Unspecified
FL041224400Medicaid